Hearing loss may not be commonly thought of as a complication of diabetes. How did you become interested in the condition?

As a diabetes educator, when I think of diabetes complications, I think of kidney, eye, heart and nerve damage. What I don’t think about is hearing loss. In 2012, a colleague asked me what screenings I do for my patients to determine if they have hearing loss. I realized I did nothing because hearing loss really was never on my radar. Then she asked me to think about how a patient who has diabetes might feel if they also had trouble hearing. I started to think about how hearing loss can not only make life more difficult, but could also lead to depression. For a diabetes patient who is already dealing with the pressures of a complicated disease, adding hearing impairment to the list of stressors would be devastating. So, I decided that this was something worth discussing with other diabetes educators.

How common is hearing loss among people with diabetes?

I did some research, and it turns out that nearly 26 million people in the United States have diabetes, and an estimated 36 million people have some type of hearing loss (17%). NIH has found that hearing loss is twice as common among people with diabetes as among those who don’t have the disease. Also, of the 79 million adults thought to have prediabetes, the rate of hearing loss is 30% higher than in those with normal blood sugar levels.

Research suggests that diabetes may lead to hearing loss by damaging the nerves and blood vessels of the inner ear. Autopsy studies of patients with diabetes have shown evidence of such damage.

A recent study from Handzo and colleagues found that women between the ages of 60 and 75 years with well-controlled diabetes had better hearing than women with poorly controlled diabetes, with hearing levels similar to those of women of the same age without diabetes. The study also showed significantly worse hearing in all women younger than 60 years with diabetes, even when the disease is well controlled.

Additionally, a study by Bainbridge and colleagues showed that 54% of people with diabetes had at least mild hearing loss in their ability to hear high-frequency tones, compared with 32% of those with no history of diabetes. And 21% of participants with diabetes had at least mild hearing loss in their ability to hear low- to mid-frequency tones, compared with 9% of those without diabetes.

People with diabetes are 2.3 times more likely to have mild hearing loss, defined as having trouble hearing words spoken in a normal voice from more than 3 feet away. But the effects of hearing loss go beyond the ability to detect sound. Hearing loss is shown to lead to sadness and depression increasing with severity of hearing loss; worry and anxiety, including periods of a month or longer when the patient reports feeling worried, tense or anxious; paranoia (“people get angry at me for no reason”); less social activity; and emotional turmoil and insecurity.

What can diabetes educators do to help patients with hearing loss?

Encourage diabetes patients to be screened routinely for hearing loss, just as they are for eye and kidney problems. Those with mild to severe impairment should be referred to an audiologist for more intense screening and treatment.

Treatment for hearing loss will typically start with a hearing aid. Often this will alleviate the problem. In about 10% of the population, medication may also be necessary, but most hearing loss is corrected with the introduction of a hearing aid. With improved hearing, patients will also likely experience increased alertness; improved job performance, memory and mood; less loneliness, fatigue, tension, stress, negativism and anger; better relationships and feelings about themselves; and greater independence and security — improved overall quality of life.

The bottom line is that diabetes educators must remember to add this to their diabetes education curriculum. They should know the resources in their area and have a process for referring patients to an audiologist who can do more extensive screenings as well as order and fit patients for hearing aids. Lastly, they should follow up with patients with hearing loss about overall quality of life. I am sure they will surprised how much adding this one aspect of care can benefit the lives of their patients.

Joanne Rinker, MS, RD, CDE, LDN, is Senior Director for Community Health Improvement at Population Health Improvement Partners and the 2013 American Association of Diabetes Educators (AADE) Diabetes Educator of the Year. She has been elected to the AADE Board of Directors 2015-2018. She can be reached at jorinker@gmail.com.

Susan Weiner, MS, RDN, CDE, CDN, is the 2015 AADE Diabetes Educator of the Year and author of The Complete Diabetes Organizer and Diabetes 365 Tips For Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com.